Interview with Rhiannon, Crisis Response & Discharge To Assess
Name and role?
“I’m Rhiannon and I am the lead pharmacist for Crisis and Discharge to Access in South Manchester.”
How long have you been here?
“I first started working with Discharge to Assess in Central in 2018. I then joined Manchester Community Response full-time in 2019 and became the Lead Pharmacist in 2020.”
What’s your background and what attracted you to the role?
“When I first qualified as a pharmacist, I was working in the hospital at Manchester Royal, and it was rotational. It was great seeing lots of specialities and stuff, but to be fair, I ended up moving over to Community because I wanted more free time… I was one of eight people on a 16-person rota.
It’s interesting because I think for Pharmacy in the Community, people still don’t know exactly what we do and what impact we can have on things. I remember when I first moved over, people asked ‘Why are you moving over to Community?’ and I was like, ‘I want to try something new and different, work lifestyle and balance’. I just thought I’d give it a go.
I feel like the impact I have here is so much better compared to when I was in the hospital. In the hospital, I could check 30 drug charts a day, do admissions and discharges, but anyone can do that now. I feel like I actually get a chance and an opportunity to impact on the patient journey and really help with the problems they’re facing. Being able to spend that time with patients and help to sort their problems out is something that I really enjoy and I think is so valuable.
There are some crazy statistics, actually — a sixth of admissions can be linked back to medication. It’s so great that I’m embedded in a team like this and have an impact on that.”
How often are you based in the community?
“I suppose my role is a little bit different because I am the lead over the two services (Crisis Response and Discharge to Access) and because I have other background things going on and things each week is different. Sometimes I might not go on a visit for a week. Sometimes I’ll be out multiple times in a week. So this week I’ve had three visits and stuff. So it just depends on the needs of the service and what I can do as well.”
How would you describe a community-based setting?
“So I suppose from a pharmacy perspective, when the patient is outside of their usual environment, they can tell you whatever they like about their medication. ‘I take all my medicines. I have no problems with things. Everything’s grand’. But, when you’re seeing a patient in their own environment and they say, ‘I take all my medicines’ and you can point in the corner and say ‘well, there’s six months’ worth of medication there.’
So in some respects, it gives an opportunity to explore further with patients. Because, especially around medication, I feel like people sometimes think they have to take everything they’re told. When I can turn around and say ‘Actually, let’s stop this’ they respond well. No one likes taking medication, let’s be honest.
Being able to have that opportunity to address things like that with people is so important because it gives patients a bit of an open conversation to have those discussions that I think they don’t ever get otherwise.
Being in the home makes things more comfortable and you can actually see what’s going on, which is important too.”
What are the rewards and the challenges in your role?
“Well, I almost think both the biggest challenge and the most rewarding thing is patient contact. Within the teams, I know the value that I can have, and patients love it as well because as I say, they often don’t get that close opportunity to discuss their medicines.
Even simple things, for example – I spoke to a patient’s daughter yesterday and she told me that the patient doesn’t take a particular medication in the evening so I was able to say ‘Great, let’s stop that’ and she told me how helpful that would be. I know that is the bit that patients benefit the most from.
I think the thing I find the most frustrating is my capacity, because I don’t always have the time to spend time with each different patient. I suppose that is possibly the hardest thing because I prioritise and I assess and I work out who’s going to have the highest impact and value and things like that. So that’s where my time is spent. I love to chat with everyone, but that’s not always the case.”
What’s a good day like in Community Response?
“So, yesterday we got a call saying a patient had been discharged and needed assessing. They’ve got a new diagnosis and have gone from being completely independent to immobile. Now the patient is having care in a hospital bed with full-time daily carers. They’ve also got CHC (NHS Continuing Healthcare) in place so they’re sadly getting towards that end-of-life stage as well.
The patient’s partner was extremely overwhelmed with a number of things going on, but one of the issues was medication. I went to visit and ended up spending quite a bit of time there, providing explanations.
They knew what some of the medicines were, but didn’t know how it they all related together, so I spent time explaining all of that to her.
Because we are a very holistic service as well…
When I went this morning to see the patient, they were quite chesty and part of my role within this service — and something I feel like not many pharmacists do — is I have my clinical skills, so I was able to listen to their chest and work out what was going on. The family were worried because the patient was due for chemotherapy soon, so I linked with the GP to discuss that.
While I was there, I also managed to have a chat with the District Nurses regarding another issue and work out what products they need. I then was able to request this, immediately from the GP.
I suppose I think that’s another strength of our service. We can look at the patient as a whole. I could have just gone in and said ‘yeah, medication, medication done’ but there are other things we can do to have an impact as well.”
Why join Community Response?
“I think I would tell anyone who is curious about the role just to come and give it a go. I think we’re a very unique team in the way we work — we are acute care in the community and I think sometimes that’s what people worry about — especially if they’re transitioning from hospital, that there’s a bit of an association, that community is slow and it’s boring and it’s not in the slightest. Come and spend time with us and you will realise that.
The nice thing as well is the impact we can have on the patient journey and the value we add too. It’s incredible. Patients are always so grateful for our services and, especially where we sit, we’re at that crisis breaking point as well.
When patients are feeling like they’re stuck or that they’ve struggled to get into services like the GP, or they don’t want to go wait for a long time at A&E and things. This is where we have our value added. The work we do is so important and it’s so rewarding as well. That’s the reason I’ve been here for almost five years now.”